Counties run out of drugs as standoff over funds persists

Mr James Muthee is alone in the ward at Nanyuki and Teaching and Referral Hospital after relatives of other patients took them for medication in the neighbouring counties. [Jacinta Mutura, Standard]
Paralysis looms in hospitals across the country as the cash crunch begins to hit the health sector following the delay in passing of the Division of Revenue Bill 2019.

The Bill that paves the way for release of funds by the National Treasury to the 47 counties hit a snag after the Senate and the National National Assembly failed to agree on the amount to be disbursed to the counties.
Interviews with several county governments revealed that they have started feeling effects of the stalemate, with some hospitals going without drugs and essential medical consumables.
Patients have been forced to seek alternative health services in private hospitals and nearby counties after health workers abandoned work due to non-payment of salaries.
Failed to implement
Council of Governors chair Wycliffe Oparanya said most counties have exhausted their supplies and cannot get drugs from the Kenya Medical Supplies Authority (Kemsa) before clearing debts.
“The effects of the stalemate have started biting them because Kemsa cannot supply drugs due to the money the counties owe them,” he said.

By now, counties should have procured drugs and other medical supplies for the first quota in this financial year. They are using supplies received in June that were meant to last for three months.
In Kakamega County, Mr Oparanya said he procured medical supplies worth Sh120 million in May because of the hiccups in passing Division of Revenue Bills every year.
In Nyeri County, the number of patients seeking medical attention has doubled due to on-going strike by health workers in Kirinyaga County.
“We had done purchases for medical supplies that were to take us to end of August but patients from neighbouring counties are now exhausting the little that has remained. We do not know what will happen if the stalemate is not resolved before next month,” said Nyeri Governor Mutahi Kahiga.
Karatina Level Four Hospital in Nyeri County is the most affected with the influx of patients seeking inpatient and outpatient services from Kirinyaga County due to the proximity. Doctors in Kirinyaga County are on strike due to non-payment of salaries.
Other patients come from as far as Laikipia County where health workers are on strike after the administration failed to implement the Collective Bargain Agreement.
However, Nandi Governor Stephen Sang said they have acquired medical consumables that would take them a few more days.
“We have not gotten to the crisis level, but I know many of my colleagues are battling to have the hospitals operate but the situation across the country is bad. Anymore delays in the disbursement of money will cause a serious problem,” said Sang.
In Mandera, the situation is expected to worsen if August salaries are not paid.
There are fears that a disease outbreak in Somalia or Ethiopia could have devastating effects as the patients seek treatment in the county.
“The disease burden is huge and we treat patients who are not Kenyans on many occasions. In a normal scenario, our services and drug supplies are overstretched. Beyond September, a crisis is looming if the revenue stalemate is not resolved,” said Governor Ali Roba, adding that the current supplies can only last until the end of September.
Mandera County’s account with Kemsa is currently in arrears and with the drought in North Eastern, families are staring at malnutrition.
Mandera is currently fighting cholera outbreak in Takaba that has seen the county government partner with Save the Children Fund in intervention.
“We are seeing Kalazaar disease sweeping from Wajir County and Somalia border yet Mandera County is not listed as a Kalazaar zone. We pray it does not stretch the meagre resources in Madera further,” Roba added.
In Kisumu, the government maintained a studious silence even as health workers abandoned work for the fifth day, subjecting patients to untold suffering.
Wards at Jaramogi Oginga Odinga Teaching are Referral Hospital (JOORH) and the Kisumu County Hospital remained empty by close of day yesterday after patients were discharged.
There have been cries of pain and helplessness at the out-patient waiting bays in the two main hospitals and health centers across the county.
A spot check by Saturday Standard at the health facilities revealed slow services with nurses and clinical officers vowing not to resume work until they are paid July and August salaries.
Other health facilities affected are Lumumba, Papa Onditi, Ahero, Chulaimbo and Nyalenda health centers.
Staff at the hospitals said they are facing shortage of drugs and non-pharmaceuticals as suppliers had also not been paid.
At Jaramogi Oginga Odinga Teaching are Referral Hospital and the County Referral hospitals, only officials working for local NGOs are offering HIV and Aids services.
“Some are weak and they need immediate medical care but there is nothing we can do to help them,” said Millicent Aketch, a worker with a local NGO. One of the patients, James Onyango, had his Universal Health Care (UHC) card which he said was his only hope in accessing health services, but there is no one to receive the card or treat him.
“I have used it before but now without money, I do not know what to do I am in deep pain,” wept Onyango.
Staged protests
As we moved through the corridors of wards at the Kisumu county referral hospital, we met pregnant mothers who were being helped by nurses from NGOs.
The Kenya Medical Practitioners and Dentist Union, Kenya Union of Clinical Officers (KUCO), Kenya National Union of Nurses (KNUN) and Kenya Union of laboratory technologists staged protests to demand salaries.
The KNUN Kisumu brunch secretary Maurice Opetu said the workers won’t sacrifice anymore for the county until they are paid.
A letter seen by the Saturday Standard dated August 15, addressed to secretary-general KNUN signed by George Okongo, acting County Secretary, stated that the county government is making efforts to pay July salaries.
“We are at advanced stages negotiating with banks to offer emergency facilities to enable us pay the salaries by end of this week, “read part of the letter. They are demanding salaries of July and statutory deductions of three months which have not been remitted including the NHIF, Pension and loans that have not been serviced since May.
The KUCO branch secretary Craus Okumu accused the county officials for disregarding the value of healthcare workers.
He explained that health workers survive on loans which have not been serviced:” We are going to continue parading and demanding for the gross salaries nobody is going to work until our salaries are paid,” noted Okumu.
But the County Government Workers Union, Kisumu County Chapter secretary Rashid Ondu, said more than 3000 workers had resumed work following a commitment letter by the county government to pay them by Friday last week.
The county director communication Aloice Ager said the county government shared letters of commitment to each union stating the efforts being made to have them paid.
Health workers in Mombasa County downed tools a week ago over salary arrears.
[Reports by Everlyne Kwamboka, Mactilda Mbenywe and Lydiah Nyawira]

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